Provider Demographics
NPI:1124299904
Name:ROTHHOLTZ, VANESSA SHANA (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:SHANA
Last Name:ROTHHOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DR STE 975
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4541
Mailing Address - Country:US
Mailing Address - Phone:310-201-0717
Mailing Address - Fax:
Practice Address - Street 1:414 N CAMDEN DR STE 975
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4541
Practice Address - Country:US
Practice Address - Phone:310-926-1573
Practice Address - Fax:310-926-1563
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98964207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology